MDNews - Long Island

"Hypofractionated [whole-breast] radiation after surgery represents high-value cancer care that is underutilized. It's no more toxic than longer-duration treatment, it's less expensive, and it helps patients get back to work or home and put their treatments behind them faster." — Justin Bekelman, MD, Associate Professor of Radiation Oncology at the Abramson Cancer Center at Penn Medicine Briefer, Cheaper Breast Cancer Treatment Underutilized, Study Finds By Tiffany Parnell B REAST- CONSERVING SURGERY FOLLOWED by whole-breast irradiation is the most common treatment for early-stage breast cancer. In 2011, a task force from the American Society of Radiation Oncology published guidelines endorsing hypofractionated whole-breast irradiation — a modality that shortens treatment from fi ve to seven weeks to roughly three to fi ve weeks — for certain candidates. Despite the updated guidelines, however, many physicians still employ conventional radiotherapy, according to a study published in the Journal of the American Medical Association. Investigating Adoption Rates To shed light on hypofractionated whole-breast irradiation usage and potential cost savings, Justin Bekelman, MD, Associate Professor of Radiation Oncology at the Abramson Cancer Center at Penn Medicine, and a team of researchers examined administrative claims data from 14 commercial health plans using the HealthCore Integrated Research Database. Nearly 16,000 breast cancer patients' records, spanning 2008–2013, were studied. During the usage and cost analysis, patients were split into two groups: hypofractionated- endorsed and hypofractionated-permitted. Women in the hypofractionated-endorsed group met diagnostic criteria set forth by the American Society of Radiation Oncology. Women in the hypofractionated-permitted group varied from established criteria for reasons including an age younger than 50, prior chemotherapy and auxiliary lymph node involvement. The study found that 34.5 percent of women in the hypofractionated-endorsed cohort and 21.2 percent of women in the hypofractionated-permitted group received hypofractionated whole-breast irradiation in 2013. This represents an improvement over rates observed in 2008 before the guidelines were published — 10.6 percent and 8.1 percent, respectively — but shows that many women may be undergoing lengthier, costlier treatments than necessary. In terms of cost savings, healthcare expenditures were roughly 10 percent less for women who had hypofractionated whole-breast irradiation. Rethinking Treatment Approaches Further research is needed to better understand why physicians haven't more widely adopted the hypofractionated approach, according to Lori Pierce, MD, FASCO, FASTRO, Professor of Radiation Oncology and Vice Provost of Academic and Faculty Affairs at the University of Michigan. She notes that some physicians may have lingering concerns about radiation toxicity and says some women in her practice choose conventional radiotherapy — even though hypofractionated radiotherapy may allow them to fi nish treatment sooner — because a wider body of evidence supports its effi cacy. To help women make informed decisions about treatment, Dr. Pierce recommends physicians discuss the risks and benefi ts of both approaches. ■ A RECENT STUDY REVEALS THAT HYPOFRACTIONATED WHOLE-BREAST IRRADIATION IS UNDERUTILIZED IN THE UNITED STATES — MEANING BREAST CANCER PATIENTS FREQUENTLY UNDERGO LONGER, MORE EXPENSIVE TREATMENT. SPECIAL CLINICAL SECTION: ONCOLOGY 2 6 | Long Island MD NEWS ■ M D N E W S . CO M

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